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HomeMy WebLinkAboutLinden St. #21 apt.1 - 3/20/1993DEPARTMENT OF PUBLIC HEALTH/DEPARTMENT OF LABOR i INDUSTRIES NOTIFICATION OF DELEADIMG WORK '= All sertions of this form.bust be cospleted in order to oasply with the notification reguiresents of M.C.L. C. 111 5197 FILE NUMBER Contractor Performing project d�j2N Cu, !hld,aq 1 Certification N Lead Paint Inspector fDate of Inspection 1` /l- © j Address of Project Building Nam (if any) / Floor Street A-ydddress^ d ' LarujE� 5� � Apt. No. / City d9d?Z1/iC1 21p tJU�✓ Deltading Methods DR! SCRAPING _ EEAT:GUY ENCAPSMATZON DEMOLITION (circle all that apply) PONZA SANDING CAUSTICS �PLACE�r:/ OTHER If •other• selected, please explain Check one: dwelling is Multi -family single family ! Start date l S Y Completion Date When will work be done: as � Ps � weekan#s7 L Project Superviso^ Name Property Certificate R / -S �''�o �' 610 C, city iP/� �✓ State A zip In case of emergency �contact: /��/ Phone: day�- dN �� evening 5 9M— 0034DIS rev 216189 In accordance with Chapter 773 of the Acts of 19s7, Massachusetts General Laws C. 111 4197, 454 CNR 22.00 and 105 CNR 460.000, notice of the date and method(s) of removal or covering of paint, plaster soil or other accessible material containing dangerous levels of lead, is to be provided to the following persons At least five days prior, -to -the beginning-v"* .`eading. 1. Occupants of the dwelling unit 2. All other occupants of the residential premises, if any 3. Director, Chlldhood'Lead Poisoning prevention Program Department of Public dealth, 305 South Street, Jamaica Plain, WA 02130 4. Lead Removal Program, Bureau of Technical Services Department of Labor and Industries, Division of Industrial Safety 100 Cambridge street, Roam 1101, Boston, NA 02202 5. Local Board of Health/Code Enforcement Agency 6. Passachusetts Historical cOamission (if premises is listed on the state Register of Historic Places) The undersigned hereby states, under the penalties of perjury, that ha/she has read and understood the commonwealth of Massachusetts Deleading Regulations, 454 CNR 22.00, and Lead poisoning Prevw2tion and Control Regulations, 105 CIO 460.00, and that the information contained "n this notification is true and correct to the best Of his/her knowledge and belief„ % f i Date_ Signed: �G Grp Company: Office — Only _ — — — — — — 0�'34BI6 rev 216109